CTB TICKET AGENT Registration

October 31, 2014  |  By  | 


CTB TICKET AGENT REGISTRATION FORM I. ACCOUNT INFORMATION (to use for agent account access ONLY) EMAIL : (as your username to agent account login) PASSWORD : II. FOR AUTHORIZATION LOCATION (location to be place for ticket counter) PHYSICAL LOCATION : (location address) BUSINESS HOUR Start : ( AM / PM ) End : ( AM / PM ) III. COMPANY INFORMATION (location to be place for ticket counter) COMPANY NAME : Registration No. : COMPANY ADDRESS : CONTACT NUMBER Office : Fax : BUSINESS CATEGORY : IF Others: __________________________________________ (please indicate your business category) IV. CONTACT PERSON FULL NAME : (authorized personnel 1) JOB POSITION : NRIC NUMBER : CONTACT Email : Mobile Phone : FULL NAME : (authorized personnel 2) JOB POSITION : NRIC NUMBER : CONTACT Email : Mobile Phone : V. PAYMENT DETAIL PREPAID VALUE : IF Others: __________________________ (please indicate your prepaid value) PAYMENT METHOD : IF by CHEQUE: ________________________________ (please indicate the cheque number) Travel Agency Stationary & Printing Money Changer Telco Mini Mart Internet Cafe Hotel & Resort General Others RM 300.00 RM 500.00 RM 1,000.00 Others RM (Please tick (√) your selection) by CASH DEPOSIT by ONLINE BANKING by CHEQUE (Please tick (√) your selection) (Please tick (√) your selection)

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